[CapeCodMermaid]

DPH just exited my agency for survey. PICC lines were an issue for several reasons:
1.No documentation of correct placement
2.No documentation of how much if any the catheter had migrated out
3.No reconciliation of the length of the catheter that went in with the length of what was pulled out (doc. said 50cm cath....dc note said 40!)
4.No consistently written flush orders
5.Documentation of the site itself not consistently documented...
so.....there you have it

[bobbiern]

I just placed a PICC today and felt it went right in. I had absolutely no problems. An xray was ordered and to my dismay the PICC had been curled in the axillary vessel. I feel all PICC insertions must be determined by xray especially if your doing it without US guidance. I have placed PICC's for approximately 15 years and have never had this happen. I had left the hospital and was on my way back when the physician pulled the PICC with research I found you can reposition the PICC if you use sterile technique. Now the patient has to go through the procedure all over again.

[bobbiern]

I just placed a PICC today and felt it went right in. I had absolutely no problems. An xray was ordered and to my dismay the PICC had been curled in the axillary vessel. I feel all PICC insertions must be determined by xray especially if your doing it without US guidance. I have placed PICC's for approximately 15 years and have never had this happen. I had left the hospital and was on my way back when the physician pulled the PICC with research I found you can reposition the PICC if you use sterile technique. Now the patient has to go through the procedure all over again.

[caliotter3]

As someone with little to no experience in this area, I refused to take on a case such as this with a very small baby. The supervisory nurses were trying to browbeat me into taking the case and the non-nurse business manager was hanging on every word they said, trying to make me look incompetent and uncooperative. I had to inform the business manager of the legalities of exceeding my scope of practice and my abilities. To this day, I don't think this person ever "got it". I will never involve myself with a procedure in the home that I am not capable of performing. When I see something looming in the distance, I inform my supervisors and let the chips fall where they may.